Your Role

The Medical, Commercial Business & Clinical Strategy position is dedicated to supporting the promotion of growth and increased market share of Administrative Services Only (ASO) business. This includes strategic clinical and healthcare cost management guidance for the existing Blue Shield of CA book of business of at least 200k members. This position will report directly to the VP Provider Performance, Quality and Affordability, and have responsibility for being aligned to shared goals set with the VP of ASO Dedicated Operations. This position provides clinical direction to the sales team and sales processes and interacts directly with employers. This role will be at the center of driving strategy for how to reduce cost of care, while increasing engagement and improving the quality of care for our employer's members.

Your Work

In this role, you will:

• Represent as the Clinical lead for the Account Management teams, supporting both clinical and business objectives
• Work collaboratively with other Health Solutions and BSC staff to quickly resolve employer service issues, with particular emphasis on clinical issues. Be available to talk with key account members and employers about their issues and the solutions
• Lead employer and producer facing activities including finalist presentations and account services meetings, broker and consultant meetings, meetings with Mercer, Towers, PBGH etc. Actively participate in and guide the preparation meetings in advance of the employer meetings. Includes interpreting clinical data for employers at regular quarterly, annual or biyearly meetings
• Responsible for the planning, development, and lead the delivery of Health Solutions-related materials to employers, producers and business associations that describe and explain the operational details and value of Health Solutions capabilities, services, and programs. Includes working with the Health Data Reporting teams to analyze data trends and develop external customer reports
• Support driving enhancements to reporting capabilities and processes for effectively delivering clinical performance plan management
• Involvement in shaping the clinical model and story which drives the member experience, and how Blue Shield of CA delivers care
• Participate in clinical product pipeline development committee, driving the voice behind what our employers need
• Be a strategic thought partner for Health Care Services to develop best in class health management capabilities and help with designing and implementing some of the innovations to address the market needs
• Co-lead the direction for managing total cost of care for the employer, while bringing innovative solutions to the table to improve the experience and quality of care for members

Your Knowledge and Experience

• Unrestricted California License (MD) required
• Minimum 10 years managed care experience required
• At least five years clinical experience required
• Experience supporting Administrative Services Only (ASO) lines of business required
• Extensive experience, and familiarity, with California managed care marketplace preferred
• Knowledge and experience in National, complex account management support preferred
• Up to 25% travel within California expected
• Previous experience in a similar sales partnership role preferred
• Prior experience as a people manager preferred
• Excellent verbal and written communication skills, including ability to speak comfortably and extemporaneously to diverse audiences
• Ability to explain program, clinical, operational, and quantitative information in a business-like, clear, coherent, and comprehensible way to lay people
• Strong quantitative and analytic skills working with claims, operational, and clinical data and reports
• Excellent interpersonal communication skills, including active listening, self-management and awareness, emotional intelligence, and ability to flex interpersonal style situational
• Demonstrated ability to model a collaborative approach with internal and external stakeholders
• Strong negotiation and creative problem solving skills
• Strong skills with Microsoft Office Suite, including PowerPoint, Excel, Word and Outlook

Pay Range:

The pay range for this role is: $ 155,331.00 to $ 325,743.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.